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目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。
OBJECTIVE: To compare the effects of triptorelin and hCG on the induction of follicular maturation in levofloxacin (LE) / FSH ovulation IVF-ET therapy. Methods: 391 cycles of IVF-ET were randomly divided into GnRHa group (n = 267) and hCG group (n = 124). All patients were treated with LE / FSH ovulation induction. Up to 18 ~ 20mm, Galectin 0.1mg was used to induce follicle maturation in GnRHa group, and hCG10000IU was used to induce follicle maturation in the GnRHa group. The number of oocytes, MII egg rate, fertilization rate, cleavage rate, excellent embryo rate Pregnancy and moderate-severe ovarian hyperstimulation syndrome (OHSS) incidence. Serum E2, P and LH levels were also compared between the two groups at induction day (d0), ovulation day (d2), day before embryo transfer (d4) and day 4 after embryo transfer (d9). Results: The total Gn usage, MII egg rate, cleavage rate and the incidence of moderate-severe OHSS in hCG group were significantly higher than those in GnRHa group (P <0.05). Gn number of days, the number of oocytes, fertilization rate, implantation rate, clinical pregnancy rate, miscarriage rate was no significant difference (P> 0.05). The levels of d0LH, d2LH and d9LH in the GnRHa group were significantly higher than those in the hCG group (P <0.05), while the levels of d2P, d4E2, d4P, d4LH, d9E2 and d9P in the GnRHa group were significantly lower than those in the hCG group (P <0.05). CONCLUSIONS: The replacement of hCG with GnRHa in ovulation induction of LE / FSH induces follicular maturation without affecting IVF outcome and significantly reduces the incidence of OHSS. GnRHa induces ovarian follicular maturation of the IVF cycle in the luteal phase of the presence of luteal insufficiency, exogenous hCG need to be supplemented to enhance luteal support.